Payers and Oral Health in Primary Care

Private payers are now paying pediatricians and other primary care providers for some oral health services administered in the medical home. This includes payment for fluoride varnish application following the United States Preventive Task Force recommendations around the service (B grade preventive service to be provided without cost sharing to all children 5 (through 6th birthday) and under in the primary care office). 

Medicaid reimburses pediatricians and other primary care providers for application of fluoride varnis​h and some states also reimburse for completing a risk assessment as well as an oral screening, providing oral education, and providing caregivers with a dental referral. Fluoride varnish application is reimbursed in addition to the office visit for children 5 (through 6th birthday) and under in the primary care office. ​ 

In addition, fluoride varnish treatments are now on the Bright Futures periodicity schedule, further promoting that pediatricians should focus on integrating this 45- to 60-second procedure into their practices and strengthening their oral health messaging to families.

To find out more about private payers and oral health in your state please contact your Chapter or your Chapter Pediatric Council (many Chapters have pediatric councils which is a forum to engage private payers on pediatric issues). Medicaid programs and private payers have varying payment policies for oral health. This grid​ provides information for each state.